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MSK Anatomy Flashcards

(104 cards)

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1
Q

Joint types

A

Fibrous: cranial sutures, interosseus membrane

Cartilagenous:

  • Primary (hyaline only): ossify - growth plates
  • Secondary (+ fibrocartilage): midline - pubic symphysis

Synovial:

  • Plane
  • Hinge
  • Condylar
  • Ball and socket
  • Saddle
  • Pivot
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2
Q

Joint stability

A
  • Articular surface
  • Capsule and ligaments
  • Muscles
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3
Q

Cartilage Structure

A

Superficial layer: flattened chondrocytes that produce collagen and glycoproteins (lubricin) - parallel collagen

Transitional layer: round chondrocytes that produce proteoglycans (aggrecan)

Deep layer: horizontal collagen

75% water

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4
Q

Cartilage Function

A

Provide a smooth, lubricated surface for low friction articulation and facilitation of load transmission

  • Glycoproteins (lubricin):&raquo_space; protein
  • Proteoglycans (aggrecan)&raquo_space; carb
  • GAGs (hyaluronic acid)&raquo_space;> carb
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5
Q

Synovial fluid components and function

A
  • Hyaluronic acid
  • Lubricin
  • Blood plasma

Nutrition of cartilage, waste removal, lubrication (boundary, hydrodynamic, weeping)

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6
Q

Bursae

A

Fluid-filled sacs that reduce friction

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7
Q

Bone development

A
  1. Hyaline cartilage model
  2. Primary ossification centre develops at centre
  3. Secondary ossification centre develops at ends
  4. Medullary cavity forms in primary ossification centre
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8
Q

Bone structure

A

Epiphysis: articular cartilage, spongy/cancellous bone
Epiphyseal growth plate
Metaphysis
Diaphysis: medullary cavity, compact/cortical bone

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9
Q

Cortical/compact bone

A

Lamellae

  • Concentric: central canal with blood vessels
  • Interstitial
  • Circumferential

Biologically inactive
Resists bending and torsion

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10
Q

Spongy/cancellous bone

A

Trabeculae

  • Resists/absorbs compression
  • Very biologically active - osteoclasts, osteoblasts, osteocytes
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11
Q

Tendon structure and function

A

Collagenous structure
- Vinculum: blood supply

Connects muscle to bone

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12
Q

Ligament structure and function

A

Collagenous structure

Connects bone to bone (span a joint)

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13
Q

Axilla boundaries

A

Apex: lat. border of 1st rib, scapula, clavicle
Base: axillary fascia
Anterior: pectoralis major + minor
Posterior: subscapularis, teres major, latissimus dorsi
Medial: thoracic wall, serratus anterior
Lateral: neck/shaft of humerus

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14
Q

Axilla contents

A
  • Axillary artery
  • Axillary vein
  • Brachial plexus
  • Axillary lymph nodes
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15
Q

Brachial plexus roots

A

C5-T1

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16
Q

Brachial plexus trunks

A
  • Superior: C5-6
  • Middle: C7
  • Inferior: C8-T1
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17
Q

Brachial plexus cords

A

Named for position in relation to axillary artery

  • Lateral cord: anterior divisions of upper and middle trunk
  • Posterior cord: posterior divisions of all trunks
  • Medial cord: anterior division of lower trunk
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18
Q

Musculocutaneous nerve

A

C5-7

  • Originates from lateral cord
  • Anterior compartment of arm (BBC)

Course:

  1. Perforates coracobrachialis
  2. Descends between biceps brachii and brachialis
  3. Crosses elbow
  4. Terminal branch in forearm: lateral cutaneous nerve
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19
Q

Axillary nerve

A

C5-6

  • Originates from posterior cord
  • Deltoid and teres minor

Course:

  1. Exits axilla via quadrangular space
  2. Passes medially to surgical neck of humerus
  3. Divides into 3 terminal branches: anterior, posterior, articular
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20
Q

Radial nerve

A

C5-T1

  • Originates from posterior cord
  • BEST: brachioradialis, extensors (wrist), supinator, triceps (posterior compartment of arm)

Course:

  1. Enters anterior to medial head of triceps and runs with profunda brachii artery
  2. Descends down midshaft humerus in radial groove
  3. Lies between brachialis and brachioradialis
  4. Anterior to lateral epicondyle
  5. Cubital fossa and then terminates (deep and superficial branch)
    a. Deep branch (aka posterior interosseus nerve) runs deep to supinator (pierces to enter posterior compartment)
    b. Superficial branch runs deep to brachioradialis and enters hand above anatomical snuff box (dorsum of hand)
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21
Q

Median nerve

A

C5-T1

  • Originates from lateral and medial cord
  • Anterior compartment of forearm

Course:

  1. Descends along lateral side of axillary/brachial artery
  2. Crosses to medial brachial artery in middle part of arm
  3. Enters cubital fossa
  4. Heads under pronator teres
  5. Descends between flexor digitorum superficialis and profundus
  6. Enters carpal tunnel deep to flexor retinaculum
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22
Q

Ulnar nerve

A

C8-T1

  • Originates from medial cord
  • Intrinsic muscles of the hand

Course:

  1. Descends along medial side of brachial artery
  2. Enters posterior compartment of arm through medial intermuscular septum and runs along medial head of triceps
  3. Passes medial epicondyle posteriorly
  4. Passes between heads of flexor carpi ulnaris
  5. Descends to wrist medial to ulnar artery
  6. Enters hand superficial to flexor retinaculum
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23
Q

Arterial supply of upper limb

A
  1. Subclavian
  2. Axillary - at lateral border of the 1st rib
  3. Brachial - lower margin of teres major. Gives off profunda brachii (passes deep to triceps with radial nerve)

Radial (lateral)

  • Starts under brachioradialis
  • Runs over pronator teres, flexor pollicis longus and distal radius
  • Forms deep palmar arches

Ulnar (medial)

  • Runs distal with ulnar nerve between flexor carpi ulnaris and flexor digitorum profundus
  • Runs through wrist and forms superficial palmar arch

Palmar arches anastomose

Common digital artery
Proper palmar digital artery
Posterior interosseus artery - branch of ulnar artery

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24
Q

Venous drainage of upper limb

A
  • Dorsal venous arch
  • Cephalic (lateral)
  • Basilic (medial)
  • Median cubital (communicating vein in ante-cubital fossa:
    cephalic -> basilic)
  • Axillary vein
    Cephalic vein pierces clavipectoral fascia
    Basilic vein becomes axillary at lower border of teres minor
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25
Dermatomes of upper limb
``` C5 - deltoid (regimental badge) C6 - thumb C7 - middle finger C8 - little finger T1 - medial antecubital fossa ```
26
Lymphatic drainage of upper limb
Axillary lymph nodes: - Anterior/Pectoral: anterior thoracic wall - Posterior/Subscapular: posterior thoracic wall - Lateral/Brachial: lateral axillary wall - ^^ all drain to central nodes at base of axilla. - ^^ drains to apical nodes at apex of axilla
27
Pectoral (shoulder) girdle
Connect bilateral upper limbs to axial skeleton - Clavicle - Scapula - Acromioclavicular joint (plane) - Sternoclavicular joint (plane with fibrocartilage disc)
28
Clavicle
Connects to manubrium of sternum (SC) and acromion of scapula (AC). - Shaft is weakest - Conoid tubercle on inferior surface
29
Scapula
- Acromion - Coracoid process - Spine and spinous process - Supra/infraspinous fossa (posterior) - Subscapular fossa, lateral/medial border and superior/inferior angle (anterior) - Glenoid cavity and supra/infraglenoid tubercles
30
Coracoid process attachments
3 muscles - Pectoralis minor - Biceps brachii (short head) - Coracobrachialis 3 ligaments - Coracohumeral - Coracoacromial - Coracoclavicular
31
Scapulo-humeral rhythm
Abduction - First 30 degrees caused by muscles acting at gleno-humeral joint - >30 degrees requires scapula-thoracic movement: elevation and lateral rotation
32
Elevation (superomedial) of scapula
1. Trapezius (superior fibres) 2. Levator scapulae 3. Rhomboid minor and major All medial border of scapula insertion
33
Depression of scapula
1. Gravity 2. Latissimus dorsi 3. Serratus anterior 4. Pectoralis major and minor 5. Trapezius (inferior fibres)
34
Protraction (forward movement) of scapula
1. Serratus anterior | 2. Pectoralis major and minor
35
Retraction (backward movement) of scapula
1. Trapezius (middle fibres) 2. Rhomboid major and minor 3. Latissimus dorsi
36
Lateral (upward) rotation - elevate glenoid cavity
1. Trapezius | 2. Serratus anterior
37
Medial (downward) rotation - depress glenoid cavity
1. Gravity 2. Levator scapulae 3. Rhomboids 4. Pectoralis minor
38
Gleno-humeral joint
Ball and socket synovial joint. | Glenoid labrum is a rim of cartilage that deepens the socket providing stability
39
Ligaments of shoulder joint
- Coracoacromial arch (superior) - Coracohumeral (superior) - Glenohumeral (anterior) - Transverse humeral (stabilises long head of biceps)
40
Bursae of shoulder joint
Subacromial (subdeltoid) - Between infra-/supraspinatus muscles and deltoid to reduce friction beneath deltoid (promoting movement of rotator cuff muscles) - Injury by repetitive overhead movements Subscapular - Communicate with joint cavity
41
Rotator Cuff muscles (SITS)
Stabilise the gleno-humeral joint Innervation: C5-6 External (lateral) rotators: 1. Infraspinatus - Infraspinous fossa - Greater tuberosity of humerus 2. Supraspinatus - Supraspinous fossa - Greater tuberosity of humerus 3. Teres minor - Lateral border of scapula - Greater tuberosity of humerus Internal (medial) rotator: 4. Subscapularis - Subscapular fossa of scapula - Greater tubercle of humerus (anterior)
42
Shoulder dislocation
Weakest part of capsule is anteroinferior. Anterior more common Axillary nerve damage (loss of sensation at regimental badge area)
43
Deltoid muscle
- Origin: lateral spine of scapula Passes across acromion to lateral third of clavicle - Insertion: deltoid tuberosity of humerus - Function: flexion, abduction and extension - Innervation: axillary nerve
44
Pectoralis major
- Origin: medial third of clavicle, sternum and costal cartilage of ribs 1-6 and rectus sheath - Insertion: lateral lip of bicipital groove of humerus - Function: adduct, flex and medially rotate humerus
45
Pectoralis minor
- Origin: 3-5th ribs - Insertion: coracoid process - Function: stabilise scapula (with serratus anterior), splits axillary artery into 3
46
Serratus anterior
Stabilise and protraction of scapula. - Long thoracic nerve (C5-7) - Dysfunction leads to winging (long thoracic nerve damage during breast surgery common)
47
Trapezius
- Origin: occipital, spinous process T1-12 - Insertion: lateral 1/3 clavicle, acromion, spine of scapula - Function: elevate (superior), retract (middle) and depress (inferior) scapula - Innervation: CNXI
48
Flexion of shoulder
1. Deltoid 2. Pectoralis major 3. Corachobrachialis
49
Extension of shoulder
1. Deltoid 2. Latissimus dorsi 3. Teres major and minor
50
Adduction of shoulder
1. Pectoralis major 2. Latissimus dorsi 3. Teres major 4. Triceps brachii
51
Abduction of shoulder
0-90: supraspinatus, deltoid | 90-180: trapezius, serratus anterior
52
Medial/internal rotation of shoulder
1. Subscapularis 2. Latissimus dorsi 3. Pectoralis major 4. Teres major
53
Lateral/external rotation of shoulder
1. Infraspinatus 2. Supraspinatus 3. Teres minor
54
Latissimus dorsi
- Origin: broad - T7-12 spinous processes, ileal crest, ribs 9-12 - Insertion: Intertubercular sulcus of humerus (anterior) - Function: Depression, internal rotation, adduction, extension
55
Humerus
Anterior: - Greater (SIT) and lesser tubercle - Intertubercular groove (t. major and lat dorsi) - Deltoid tuberosity - Coronoid fossa - Radial fossa - Trochlea - Capitulum Posterior: - Head - Neck (anatomical then surgical) - Shaft - Radial groove - Olecranon fossa - Medial epicondyle
56
Elbow joint
Synovial hinge (180 degrees) - Trochlear notch (ulna) and trochlea - Head of radius and capitulum Bursae: intratendinous, subtendinous, subcutaneous (olecranon)
57
Elbow ligaments
- Radial collateral ligament (medial epicondyle and coronoid process -> olecranon of ulna) - Ulnar collateral ligament (lateral epicondyle -> annular ligament of radius)
58
Epicondylitis
Repetitive overused of forearm muscles results in inflammation of muscle tendons attached to epicondyles Lateral: tennis elbow Medial: golfer's elbow
59
Radio-ulnar joints
- Proximal (annular ligament keeps radius in place) and distal - Pivot-type to allow supination and pronation
60
Anterior compartment of the arm
Biceps brachii, coracobrachialis and brachialis - Musculocutaneous (BBC) nerve - Flexion
61
Biceps brachii
- Long head: supraglenoid tubercle (intertubercular groove) - Short head: coracoid process - Radial tuberosity - Bicipital aponeurosis to deep fascia of forearm - Flexion of elbow + arm - Supination of forearm
62
Coracobrachialis
- Coracoid process - Mid-shaft humerus (medial) - Flexion and adduction of arm
63
Brachialis
- Distal shaft humerus (anterior) - Coranoid process of ulna - Flexion of elbow
64
Posterior compartment of arm
Triceps brachii and anoceus - Radial nerve - Extension of forearm (+ arm)
65
Triceps brachii
- Long head: Infraglenoid tubercle - Lateral head: Posterior humerus (above radial groove) - Medial head: Posterior humerus (below radial groove) - Olecranon process of ulna
66
Ancoceus
- Lateral epicondyle of humerus | - Olecranon process of ulna
67
Cubital fossa
Boundaries - Lateral: medial brachioradialis muscle - Medial: lateral border of pronator teres muscle - Superior: imaginary line between epicondyles - Floor: brachialis and supinators - Roof: skin and fascia Contents: - Radial nerve - Biceps tendon - Brachial artery - bifurcation at radial neck - Median nerve Note: Median cubital vein lies anterior. Cephalic lies laterally and basilic lies medially
68
Supination
Biceps brachii and supinator
69
Pronation
Pronator teres and pronator quadratus
70
Anterior compartment of the forearm
Flexion of wrist and pronation of forearm Superficial: - Brachioradialis - Pronator teres - Flexor carpi radialis - Flexor carpi ulnaris - Palmaris longus Intermediate: - Flexor digitorum superficialis All except brachioradialis originate from medial epicondyle (common flexor origin) Deep: - Flexor digitorum profundus - Flexor pollicis longus - Pronator quadratus All median nerve except ulnaris, brachioradialis and some of FDP
71
Pronator teres
Anterior compartment of forearm - Medial epicondyle - Radius (lateral) - Pronation and elbow flexion - Median nerve
72
Flexor carpi radialis
Anterior compartment of forearm - Medial epicondyle - Metacarpals 2-3 - Wrist flexion, abduction (radial deviation) - Median nerve
73
Flexor carpi ulnaris
Anterior compartment of forearm - Medial epicondyle - Pisiform, hamate, metacarpal 5 - Wrist flexion, adduction (ulnar deviation) - Ulnar nerve
74
Flexor digitorum superficialis
Anterior compartment of forearm (intermediate) - Medial epicondyle - Intermediate phalanges of digits 2-5. Note: makes tunnel for FDP tendons - Wrist and finger flexion - Median nerve
75
Flexor digitorum profundus
Anterior compartment of forearm (deep) - Ulna + interosseus membrane - Distal phalanges 2-5 (palmar) - Flexion: metacarpophalangeal, interphalangeal, wrist - Dual nerve supply: median (2-3) and ulnar (4-5)
76
Flexor pollicis longus
Anterior compartment of forearm (deep) - Radius + interosseus membrane - Distal phalanx of thumb - Flexion of thumb: metacarpophalangeal, interphalangeal - Median nerve
77
Pronator quadratus
Anterior compartment of forearm (deep) - Distal anterior ulna - Distal anterior radius - Pronation (with pronator teres) - Median nerve
78
Brachioradialis
- Lateral supracondylar ridge of humerus - Styloid process of radius - Elbow flexion (lies in posterior compartment) and pronation - Radial nerve
79
Carpal tunnel
Passageway from forearm to hand passing deep to the flexor retinaculum (fibrous band) - 4 carpal bones: scaphoid and trapezium (lateral) and pisiform and hamate (medial) Function: transmits structures - 4 FDS tendons - 4 FDP tendons - 1 tendon of FPL - Median nerve
80
Thenar compartment of the hand
Control thumb movement - Abductor pollicis brevis - Flexor pollicis brevis - Opponens pollicis (deep) - Median nerve - Ulnar nerve: deep belly of FPB
81
Hypothenar compartment of the hand
Control 5th digit movement - Abductor digiti minimi - Flexor digiti minimi - Opponens digiti minimi - Ulnar nerve
82
Central compartment of the hand
- Flexor tendons from forearm: FDS, FDP, FPL - Lumbricals - 4 muscles that arise from the medial and lateral aspects of the FDP tendon between the 1st-5th metacarpals Lumbricals: - Flexion at metacarpophalangeal 2-5 - Extend at interphalangeal 2-5 - 3,4 - ulnar - 1,2 - median
83
Adductor compartment of the hand
Adductor pollicis - Oblique and transverse head - Adduction of thumb - Ulnar nerve
84
Interosseus compartment of the hand
Lie between metacarpal bones 4 dorsal: abduct fingers (DAB) - 1 -> 2nd digit - 2,3 -> 3rd digit - 4 -> 4th digit 3 palmar: adduct fingers (PAD) - 1 -> 2nd digit - 2 -> 4th digit - 3 -> 5th digit - Ulnar nerve (deep branch)
85
Upper limb motor nerve testing
Axillary: abduct shoulders (deltoid) Musculocutaneous: flex elbow (ant. compartment arm) Radial: extend wrist (post. compartment forearm) Ulnar: spread your fingers (intrinsic hand) Median: thumb towards nose (abductor pollicis brevis)
86
Upper limb sensory nerve testing
Axillary: regimental badge area Musculocutaneous: lat. aspect of forearm Radial: post. arm, forearm, dorsal lateral 3 1/2 fingers Ulnar: palmar/dorsal aspect of medial 1 1/2 fingers Median: palmar lateral 3 1/2 fingers
87
Radius and ulna
Radius - Radial tuberosity - Styloid process - Head Ulna - Olecranon process - Trochlear notch
88
Wrist
Carpal bones - Scaphoid (most commonly fractured) and lunate - articulates with radius - Triquetrum - Pisiform - Hamate - Capitate - Trapezoid - Trapezium Between ulna and carpal bones is triangular fibrocartilage complex (TFCC)
89
Movements of wrist
Flexion: anterior compartment of forearm Extension: posterior compartment of forearm Adduction (ulnar deviation): flexor/extensor carpi ulnaris Abduction (radial deviation): flexor/extensor carpi radialis Circumduction
90
Hand
Carpals - Carpometocarpal joint Metacarpals - Metacarpophalangeal joint Proximal phalanges Middle phalanges - 2-5 only Distal phalanges - Interphalangeal joint
91
Posterior compartment of forearm
Extend wrist joint - Extensor carpi radialis longus - abduct - Extensor carpi radialis brevis - abduct - Extensor carpi ulnaris - adduct Extend medial 4 digits - Extensor digitorum - Extensor indices - Extensor digiti minimi Extend or abduct thumb - Abductor pollicis longus - Extensor pollicis longus - Extensor pollicis brevis Supinator - supination - Radial nerve (C5-8)
92
Medial epicondyle attachments
``` Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorum superficiales ```
93
Lateral epicondyle attachments
Extensor carpi radialis brevis Extensor carpi ulnaris Extensor digitorum Supinator
94
Anatomical snuff box
Medial: Extensor pollicis longus (EPL) tendon (inside) Lateral: Extensor pollicis brevis tendon and abductor pollicis longus tendon (outside) Floor: scaphoid and trapezium and radial artery Proximal: styloid process of radius
95
Dorsal digit (extensor) expansion
Formed by flattening of four extensor digitorum tendons - At base of proximal phalanx - Extensor digitorum carries on and crosses base of middle (middle conjoint tendon) and distal (terminal conjoint tendon) phalanx. Muscles attached to extensor expansion: - Lumbricals - Interosseus - Flexor digitorum superficialis - Flexor digitorum profundus
96
Extensor retinaculum
Provides stability and a tunnel for extensor tendons
97
Curvature in the spine
Cervical (1-7) and lumbar (1-5): lordosis Thoracic (1-12): kyphosis
98
Vertebrae structure
- Superior/inferior articular process (facet synovial joint) - Lamina of vertebral arch - Intervertebral foramen - Intervertebral disc (secondary cartilaginous) - Spinous process - Transverse process - Vertebral body
99
Spinal muscles
- Longissimus/semispinalis capitis - Longissimus/semispinalis/iliocostalis cervicis - Longissimus/semispinalis/iliocostalis/ spinalis thoracis - Erector spinae: longissimus, iliocostalis, spinalis - Iliocostalis/quadratus lumborum - Multifidus - External oblique - Psoas major and minor
100
Ligaments of the spine
- Anterior/posterior longitudinal ligaments - Ligamentum flavum - Inter/supraspinous ligaments - Intertransverse ligaments
101
Myotome
Group of muscles innervated by a single spinal nerve
102
Dermatome
Area of skin innervated by a single spinal nerve
103
Spinal cord
Ends at L1 | - becomes conus medularis
104
Intervertebral disc
- Secondary cartilaginous joint - Structure: annulus fibrosis and nucleus pulposus - Function: shock absorber, resists rotation - Ageing: decreased water content -> degenerative changes

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